Breast cancer survivors, particularly older women, are at greater risk of death from non-cancer causes than from breast cancer.

As breast cancer treatments improve, patients are surviving longer, and many are dying of causes unrelated to breast cancer. Judith-Anne Chapman, Ph.D., and colleagues with the National Cancer Institute of Canada Clinical Trials Group investigated whether certain factors, such as pre-existing diseases, are associated with the risk of death from breast cancer, other cancers, or causes other than cancer. For about four years, the researchers followed over 5,000 women enrolled in a breast cancer trial.

During the follow-up, 256 participants died. Non-breast cancer deaths were more common than deaths from breast cancer, and older women, in particular, were more likely to die of other causes. While 60 percent of women in the trial died of causes not related to breast cancer, this figure jumped to 72 percent among women 70 years and older. Two factors were associated with cause of death. Women with pre-existing heart disease were more likely to die of non-cancer causes, and women with pre-existing osteoporosis were at greater risk of dying from cancers other than breast cancer. Women were more likely to die from breast cancer if cancer cells had spread to the lymph nodes.

Routine use of screening mammography and improved therapeutic management of breast cancerwill mean that more women will survive breast cancer to older ages, at which they might have a higher risk of death from causes other than breast cancer, the authors write.

In an accompanying editorial, Sharon Giordano, M.D., and Gabriel Hortobagyi, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston discuss the need for oncologists to consider a patients pre-existing health problems when determining treatment options.

For example, cardiovascular disease is of particular concern to breast cancer patients because of its prevalence and the reality that many therapies for breast cancer can cause cardiac dysfunction, the editorialists write.

A certain variation in a DNA repair gene is associated with an increased risk of developing a type of brain cancer called meningioma.

Meningioma is an uncommon brain tumor that occurs in the meninges, the membranes that cover the brain and spinal cord. Relatives of meningioma patients are at greater risk of developing the cancer, but exposure to radiation also increases ones risk for the disease.

A SNP known as rs4968451, which is in a breast cancer susceptibility gene, was associated with increased risk of meningioma. Almost 30 percent of Europeans carry this genetic variant, which, the authors write, could indicate the substantial contribution of the variant in the development of meningioma.

A syndrome that increases the risk of some skin cancers may be a subset of a syndrome that increases the risk of colon cancer.

Some people with Lynch syndromean inherited condition that predisposes a person to colon cancerare also at greater risk for developing certain skin cancers, a condition known as Muir-Torre syndrome.

Albert de la Chapelle, M.D., Ph.D., and colleagues at The Ohio State University in Columbus investigated how often Lynch syndrome patients were diagnosed with skin tumors related to Muir-Torre syndrome. The study included 152 Lynch syndrome patients from 50 different families.

Fourteen people in the study, each from different families, were diagnosed with Muir-Torre syndrome. Families that carried particular mutations in one of the DNA mismatch repair genes were more likely to have a family member with Muir-Torreassociated skin lesions than those with other mutations in the DNA mismatch repair genes.

On the basis of our results, we suggest that Muir-Torre syndrome be defined as a variant of Lynch syndrome that is characterized by mutations in all [mismatch repair] genes. We propose that Muir-Torre syndromeassociated skin lesions be included as a component tumor of the Lynch syndrome and screened for accordingly, the authors write.

Updated criteria for reporting adverse events in clinical trials are needed, according to a commentary in the Journal of the National Cancer Institute.

The Common Terminology Criteria for Adverse Events was developed by the National Cancer Institute to establish standard language for reporting adverse events that occur in NCI-sponsored clinical trials. Some newer, targeted cancer therapies that are taken daily for an extended period of time often result in side effects, such as diarrhea or nausea. But under the current reporting system, these side effects may be underreported or underappreciated in terms of their effect on a patients quality of life.

Maureen Edgerly and Tito Fojo, M.D., Ph.D., of the National Cancer Institute in Bethesda, Md., argue that revised criteria are needed for physicians and researchers to more accurately assess and report such adverse events. In particular, they suggest improvements for the classification and reporting of long-term side effects and those that affect a patients daily activities.

In an era when the number of me-too drugs (i.e., drugs that are structurally similar to known drugs) will likely increase, it will be important for clinical trials to accurately capture and report toxic effects if the FDA is to adhere to its mandate to approve drugs that are either more efficacious or with comparable activity but less toxicity that those already approved, the authors write. It is imperative that the reported data accurately reflect the long-term effects of a drug on physical functioning, quality of life, and tumor-related symptoms, in addition to its effects on disease-free survival.

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